Assessment of Patient Simulation Use in Selected Baccalaureate Nursing Programs in the United States

Simulation-Based Education in US Undergraduate Medical Education: A Descriptive Study

PURPOSE

Simulation-based education (SBE) provides experiential learning, improvement in quality of care, and reduction in errors. In 2011, the Association of American Medical Colleges described adoption of SBE in 68.0% of medical schools and 25.0% of teaching hospitals. We sought to examine current trends of SBE integration in American undergraduate medical education since previous publications.

METHODS

From 2016 to 2019, University of Texas Southwestern Medical Center postgraduate year 1 residents were invited to participate in a survey assessing medical school simulation experience with 26 clinical tasks from three categories: procedural, communication, and other. Deidentified results were analyzed to assess demographics including sex, specialty, residency program type, allopathic versus osteopathic medical school, and medical school region.

RESULTS

Nine hundred sixty-seven of 1047 (92.3%) responses were obtained, representing 139 US medical schools, 91% from allopathic training. Of procedural tasks, most simulated was suturing (n = 848, 89.6%) and least simulated was thoracentesis (n = 737, 80.9%). Of communication tasks, most simulated was taking a history (n = 475, 51.1% reporting simulation >30) and least simulated (never or ≤1) were obtaining a consent (n = 669, 73.2%) and disclosing a medical error (n = 666, 72.4%). Of other tasks, most simulated was chest compressions (n = 898, 96.0%) and least simulated was operating a defibrillator (n = 206, 22.1%). Results were similar regardless of procedural or nonprocedural program. There was no significant difference in SBE exposure between allopathic and osteopathic students ( P = 0.89). Two participants (0.002%) reported no simulation exposure.

CONCLUSIONS

Our study is the first to describe a high prevalence of SBE adoption in medical schools nationwide since the Association of American Medical Colleges' 2011 publication, with overall equal exposure for students regardless of residency type and allopathic or osteopathic medical school. Despite widespread adoption of simulation, opportunities remain to expand SBE use to teach critically important communication skills.

Maintaining Clinical Training Continuity during COVID-19 Pandemic: Nursing Students' Perceptions about Simulation-Based Learning

Background: Simulation-based learning (SBL) in nursing education is an innovative pedagogical approach that has significantly improved nursing education. Adopting SBL provides a controlled environment for meeting educational objectives without the risk of harm to real patients. Given that social distancing is required during the coronavirus disease (COVID-19) pandemic, SBL is a suitable alternative to clinical training for nursing students to learn and acquire the required clinical competencies. The study aimed to describe the effectiveness of SBL as a complete substitute for clinical experience from the perspective of students. This cross-sectional descriptive survey investigated students’ perceptions regarding the description of the effectiveness of SBL in four nursing colleges at four different universities across the Kingdom of Saudi Arabia. Settings: Four nursing colleges at four different universities across the Kingdom of Saudi Arabia. Participants included nursing students who attended simulation sessions. Data were collected by distributing a self-administrated online questionnaire, the Modified Simulation Effectiveness Tool (SET-M), which is a 19-item. Results: Approximately two-thirds of the participants were in their third (30.4%) and fourth (44.5%) academic year. The highest student presentation was for Site 1 (39.5%) and Site 2 (32.5%). Significant differences existed in all domains according to sex and university (p ≤ 0.001). There was a significant difference in relation to the level of agreement for pre-briefing, scenario, and debriefing domains (<0.001). Conclusions: SBL is a valuable teaching strategy that enhances nursing students’ self-awareness, self-confidence, clinical performance, and efficiency in performing procedures with considerable gender variation. Female students had more positive perceptions toward simulation effectiveness.

Implementation and Assessment of a Urology Education Curriculum for Nursing Residents

BACKGROUND

Urethral catheter placement is a common hospital procedure, and the urology service is often consulted for difficult catheterizations. Simulation-based education is used to improve procedural proficiency and could be used to increase confidence and comfort with difficult catheter placement. This study provides simulation-based education to help new nursing residents learn to perform independent Foley catheter placement and maintenance.

METHOD

All incoming nursing residents at our institution prospectively participated in this curriculum beginning in January 2020 (n = 291). Participants watched an instructional video and participated in a hands-on simulation.

RESULTS

Nursing trainees rated pre- to post-curriculum gains in content knowledge (p < .001) and confidence (p < .001). Participants reported that the curriculum increased their understanding of the procedure (p < .001) and that they would recommend it to peers (p < .001).

CONCLUSION

This educational initiative is a partnership between the Department of Urology and Department of Nursing to introduce and reinforce best practices for the care of patients who need Foley catheter placement and maintenance. [J Contin Educ Nurs. 2021;52(11):511-516.].

Nurse educators perceptions of simulation teaching in Chinese context: benefits and barriers

Background

Although simulated teaching was introduced to China in the 1990s, it remains underused in nursing education. Determining how Chinese nurse educators feel about using simulation in their institutions is very important for faculty training and has the potential to influence simulation implementation.

Method

This cross-sectional descriptive study was undertaken to identify the nurse educators’ experiences in the use of simulation from various regions of China. One hundred and thirty-six nurse educators provided demographic data and information about simulation implementation within their institutions and explored the perceived barriers and benefits of simulation usage.

Results

The survey data shows that 108 participants have used simulation in their work, but less than 92 (67.6%) of the respondents had used this teaching strategy more than ten times in last year. The study identified four factors hindering nurse faculty from simulation adoption: (1) concerns with student readiness; (2) the need for faculty team-building for simulation teaching; (3) lack of adequate simulation resources; and (4) thoughtful integration of simulation into nursing curricula.

Conclusions

Study data suggest that faculty training programs for simulation should be based on the nurse educators’ training needs, including systematically designed training topics, and the provision of hands-on learning simulation activities with expert feedback to help nurse educators achieve the competencies required for effective simulation-based education.

'Ward for the day': A case study of extended immersive ward-based simulation

BACKGROUND

Simulation is an important teaching strategy in the preparation of nursing students for professional practice. The focus of simulation has shifted from single patient encounters to multiple case studies provoking immersion in all the activities that are regularly performed on the ward. Extended immersive simulation cannot replicate completely the stresses of working on a 'real' ward, but it does provide a safe environment for students to practice the role of being a registered nurse.

OBJECTIVE

To evaluate satisfaction associated with student experiences of mentorship by industry partners, self-reflection on performance, and responses to clinical situations following an episode of extended immersive ward-based simulation.

DESIGN

Mixed methods case study.

SETTING

School of Nursing and Midwifery metropolitan Western Australian university.

PARTICIPANTS

A cohort of 278 final year students enrolled in a three-year Bachelor of Nursing program.

METHOD

Eight demonstration rooms were re-configured to resemble a mixed medical/surgical ward. Nursing students and manikins in each room simulated different patient scenarios. Students were organised in three-hour shifts in which to undertake the role of a registered nurse. Industry partners undertook shift coordinator and senior nursing roles. Surveys were distributed to students at the end of the two-day simulation. Student satisfaction was evaluated using the Satisfaction with Simulation Experience scale and content analysis of open-ended questions.

RESULTS

A total of 243 students (87.4%) responded to the survey. None of the scaled items had a mean score of below 4.5. Content analysis of 458 written responses identified three themes: simulation, role of registered nurse and learning.

CONCLUSION

Extended immersive ward-based simulation offers the opportunity for educators to mirror what happens in clinical practice. Students value the opportunity to safely experience simulated demands of working on a busy ward and learn how to meet workplace pressures in the delivery of patient care.

The use of psychiatry-focused simulation in undergraduate nursing education: A systematic search and review

Evidence on the use of simulation to teach psychiatry and mental health (including addiction) content is emerging, yet no summary of the implementation processes or associated outcomes exists. The aim of this study was to systematically search and review empirical literature on the use of psychiatry-focused simulation in undergraduate nursing education. Objectives were to (i) assess the methodological quality of existing evidence on the use of simulation to teach mental health content to undergraduate nursing students, (ii) describe the operationalization of the simulations, and (iii) summarize the associated quantitative and qualitative outcomes. We conducted online database (MEDLINE, Embase, ERIC, CINAHL, PsycINFO from January 2004 to October 2015) and grey literature searches. Thirty-two simulation studies were identified describing and evaluating six types of simulations (standardized patients, audio simulations, high-fidelity simulators, virtual world, multimodal, and tabletop). Overall, 2724 participants were included in the studies. Studies reflected a limited number of intervention designs, and outcomes were evaluated with qualitative and quantitative methods incorporating a variety of tools. Results indicated that simulation was effective in reducing student anxiety and improving their knowledge, empathy, communication, and confidence. The summarized qualitative findings all supported the benefit of simulation; however, more research is needed to assess the comparative effectiveness of the types of simulations. Recommendations from the findings include the development of guidelines for educators to deliver each simulation component (briefing, active simulation, debriefing). Finally, consensus around appropriate training of facilitators is needed, as is consistent and agreed upon simulation terminology.

Using Generalizability Theory to Inform Optimal Design for a Nursing Performance Assessment

The promotion of competency of nurses and other health-care professionals is a goal shared by many stakeholders. In nursing, observation-based assessments are often better suited than paper-and-pencil tests for assessing many clinical abilities. Unfortunately, few instruments for simulation-based assessment of competency have been published that have undergone stringent reliability and validity evaluation. Reliability analyses typically involve some measure of rater agreement, but other sources of measurement error that affect reliability should also be considered. The purpose of this study is three-fold. First, using extant data collected from 18 nurses evaluated on 3 Scenarios by 3 Raters, we utilize generalizability (G) theory to examine the psychometric characteristics of the Nursing Performance Profile, a simulation-based instrument for assessing nursing competency. Results corroborated findings of previous studies of simulation-based assessments showing that obtaining desired score reliability requires substantially greater numbers of scenarios and/or raters. Second, we provide an illustrative exemplar of how G theory can be used to understand the relative magnitudes of sources of error variance-such as scenarios, raters, and items-and their interactions. Finally, we offer general recommendations for the design and psychometric study of simulation-based assessments in health-care contexts.

Virtual versus face-to-face clinical simulation in relation to student knowledge, anxiety, and self-confidence in maternal-newborn nursing: A randomized controlled trial

BACKGROUND

Clinical simulations can provide students with realistic clinical learning environments to increase their knowledge, self-confidence, and decrease their anxiety prior to entering clinical practice settings.

OBJECTIVE

To compare the effectiveness of two maternal newborn clinical simulation scenarios; virtual clinical simulation and face-to-face high fidelity manikin simulation.

DESIGN

Randomized pretest-posttest design.

SETTING

A public research university in Canada.

PARTICIPANTS

Fifty-six third year Bachelor of Science in Nursing students.

METHODS

Participants were randomized to either face-to-face or virtual clinical simulation and then to dyads for completion of two clinical simulations. Measures included: (1) Nursing Anxiety and Self-Confidence with Clinical Decision Making Scale (NASC-CDM) (White, 2011), (2) knowledge pretest and post-test related to preeclampsia and group B strep, and (3) Simulation Completion Questionnaire. Before and after each simulation students completed a knowledge test and the NASC-CDM and the Simulation Completion Questionnaire at study completion.

RESULTS

There were no statistically significant differences in student knowledge and self-confidence between face-to-face and virtual clinical simulations. Anxiety scores were higher for students in the virtual clinical simulation than for those in the face-to-face simulation. Students' self-reported preference was face-to-face citing the similarities to practicing in a 'real' situation and the immediate debrief. Students not liking the virtual clinical simulation most often cited technological issues as their rationale.

CONCLUSIONS

Given the equivalency of knowledge and self-confidence when undergraduate nursing students participate in either maternal newborn clinical scenarios of face-to-face or virtual clinical simulation identified in this trial, it is important to take into the consideration costs and benefits/risks of simulation implementation.

Survey of outcomes in a faculty development program on simulation pedagogy

Although many nursing programs use simulation as a teaching-learning modality, there are few systematic approaches to help nursing educators learn this pedagogy. This study evaluates the effects of a simulation pedagogy nursing faculty development program on participants' learning perceptions using a retrospective pre-course and post-course design. Sixteen Thai participants completed a two-day nursing faculty development program on simulation pedagogy. Thirteen questionnaires were used in the final analysis. The participants' self-perceived learning about simulation teaching showed significant post-course improvement. On a five-point Likert scale, the composite mean attitude, subjective norm, and perceived behavioral control scores, as well as intention to use a simulator, showed a significant post-course increase. A faculty development program on simulation pedagogy induced favorable learning and attitudes. Further studies must test how faculty performance affects the cognitive, emotional, and social dimensions of learning in a simulation-based learning domain.

Eye tracking as a debriefing mechanism in the simulated setting improves patient safety practices

INTRODUCTION

Human patient simulation has been widely adopted in healthcare education despite little research supporting its efficacy. The debriefing process is central to simulation education, yet alternative evaluation methods to support providing optimal feedback to students have not been well explored. Eye tracking technology is an innovative method for providing objective evaluative feedback to students after a simulation experience. The purpose of this study was to compare 3 forms of simulation-based student feedback (verbal debrief only, eye tracking only, and combined verbal debrief and eye tracking) to determine the most effective method for improving student knowledge and performance.

METHODS

An experimental study using a pretest-posttest design was used to compare the effectiveness of 3 types of feedback. The subjects were senior baccalaureate nursing students in their final semester enrolled at a large university in the northeast United States. Students were randomly assigned to 1 of the 3 intervention groups.

RESULTS

All groups performed better in the posttest evaluation than in the pretest. Certain safety practices improved significantly in the eye tracking-only group. These criteria were those that required an auditory and visual comparison of 2 artifacts such as "Compares patient stated name with name on ID band."

CONCLUSIONS

Eye tracking offers a unique opportunity to provide students with objective data about their behaviors during simulation experiences, particularly related to safety practices that involve the comparison of patient stated data to an artifact such as an ID band. Despite the limitations of current eye tracking technology, there is significant potential for the use of this technology as a method for the study and evaluation of patient safety practices.

Survey of Australian schools of nursing use of human patient (mannequin) simulation

Rapid adoption of high-fidelity human patient (mannequin) simulation has occurred in Australian Schools of Nursing in recent years, as it has internationally. This paper reports findings from a 2012 online survey of Australian Schools of Nursing and builds on findings of earlier studies. The survey design allowed direct comparison with a previous study from the USA but limited its scope to the pre-registration (pre-service Bachelor of Nursing) curriculum. It also included extra mental health specific questions. Australian patterns of adoption and application of high-fidelity human patient (mannequin) simulation in the pre-registration nursing curriculum share features with experiences reported in previous US and Australian surveys. A finding of interest in this survey was a small number of Schools of Nursing that reported no current use of high-fidelity human patient (mannequin) simulation and no plans to adopt it, in spite of a governmental capital funding support programme. In-line with prior surveys, mental health applications were meagre. There is an absence of clearly articulated learning theory underpinnings in the use of high-fidelity human patient (mannequin) simulation generally. It appears the first stage of implementation of high-fidelity human patient (mannequin) simulation into the pre-registration nursing curriculum has occurred and the adoption of this pedagogy is entering a new phase.

"Coming ready or not" high fidelity human patient simulation in child and adolescent psychiatric nursing education: diffusion of Innovation

This paper is the first to address high fidelity human patient simulation (HFHPS) as a technique to prepare pre-registration nursing students for practice in child and adolescent psychiatric nursing (CAPN). By examining the published literature in a systematic review, no evidence was located that discussed the application of this innovative mannequin-based educational technique for this population. Indeed, mental health nursing preparation generally had minimal literature addressing the adoption of HFHPS. Rogers' (2003) model of the "Diffusion of Innovation" was applied as a lens to explain this observation. His model fitted this observed pattern well and provided a range of explanatory paradigms. It was limited, however, in its predictive ability to suggest when and under what conditions HFHPS might be expected to be adopted by nursing preparation programmes for CAPN. At the conclusion to this examination, the absence of a conversation evident in the mental health or CAPN literature on the preparation of pre-registration nursing students using this educational technique is striking. The potential of this approach to be combined in new ways to better prepare nursing students for the challenges of practice in mental health or CAPN needs extensive examination.

The educator inside the patient: students' insights into the use of high fidelity silicone patient simulation

AIM AND OBJECTIVE

To explore undergraduate nursing students' experiences of High Fidelity Patient Silicone Simulation.

BACKGROUND

Use of simulation as an educational tool is rapidly gaining popularity. Simulation provides a safe learning environment and helps overcome difficulties securing sufficient clinical placements. However, several limitations have been identified with this approach, particularly in relation to cost and authenticity.

DESIGN

Exploratory qualitative methodology informed the development of knowledge in this under-researched area.

METHODS

Focus group interviews were conducted with 21 nursing students and first year graduates. Participants had experienced High Fidelity Patient Silicone Simulation during the program. This involved their lecturer simulating a patient by adopting mannerisms and behaviours of a person, based on a predeveloped character and using masks and appropriate clothing to establish the visual image of a simulated patient. Thematic analysis was undertaken to identify main areas of interest to participants.

RESULTS

Two main themes are reported in this paper: 'realism of the character' and 'skills of the teacher'. Characters presented to students were viewed as realistic which enabled participants to engage with the character and take the process seriously. Knowledge and skill of the teacher was used to direct student learning experience and maximise learning benefits to be gained.

CONCLUSION

High Fidelity Patient Silicone Simulation was perceived by student participants as a highly effective teaching tool. Participants found the experience positive and believe it impacted on the quality of learning experiences.

RELEVANCE TO CLINICAL PRACTICE

Clinical experience is necessary for the development of safe and competent registered nurses. Simulation has been acknowledged as a useful adjunct to clinical experience, particularly when placements are limited. High Fidelity Patient Silicone Simulation may be used to promote realism, enhance student learning and contribute to an increase in clinical competence and confidence in nursing students.